改良Trocar直接穿刺法与Hasson开放穿刺法在后腹腔镜手术中的应用比较

doi:10.3877/cma.j.issn.1674-3253.2025.06.010

目的

本文旨在比较后腹腔镜手术中改良Trocar直接穿刺法与Hasson开放穿刺法建立腹膜后腔的安全性及有效性。

方法

回顾性收集分析2019年1月至2021年12月由同一术者完成的205例后腹腔镜手术，根据建立腹膜后腔方式不同分为两组，其中A组107例患者采用改良Trocar直接穿刺法建立腹膜后腔，B组98例患者采用Hasson开放穿刺法，分别对两组患者一般情况、穿刺平均用时、Trocar漏气、穿刺并发症、术后应用止痛药、术后疼痛（VAS）评分、切口感染情况、术后住院天数进行比较。

结果

A组建立腹膜后腔时间较B组短[（6.6±1.8） min vs （9.7±1.5）min，P<0.001]，A组Trocar漏气较B组少（P=0.030），A组出现穿刺相关并发症较B组少（P=0.039）。两组均无穿刺引起的大出血，无肾脏、大血管、肠管损伤或气体栓塞等严重并发症。

结论

改良Trocar直接穿刺法建立腹膜后腔操作快捷、安全、有效，值得在后腹腔镜手术中推广应用。

关键词: 腹腔镜, 腹膜后腔, 套管直接穿刺法, Hasson开放穿刺法

Objective

To compare the safety and effectiveness of modified direct trocar insertion and Hasson open technique in retroperitoneal laparoscopic surgery to establish a retroperitoneal space.

Methods

The data of 205 cases of retroperitoneal laparoscopy performed by the same surgeon from January 2019 to December 2021 were retrospectively analyzed, and the patients were divided into two groups, of which modified direct trocar insertion was performed in 107 patients to establish a retroperitoneal space (group A), and Hasson open technique was performed in 98 patients (group B). The general situation, average insertion time, trocar leakage, insertion related complications, application of analgesic, VAS score, incision infection, and postoperative hospitalization days of two groups were compared.

Results

The retroperitoneal laparoscopic entry time in group A (6.6±1.8 min) was shorter than that in group B (9.7±1.5 min), P<0.001. Trocar leakage was less in Group A compared to Group B (P=0.030). Insertion related complications in group A were fewer than in group B (P=0.039). Both groups had no major bleeding caused by insertion, no serious complications such as kidney, large blood vessels, intestinal injury, or gas embolism.

Conclusion

The modified direct trocar insertion is a fast, safe and effective method for establishing a retroperitoneal space, it is worth promoting in retroperitoneal laparoscopic surgery.

Key words: Laparoscopy, Retroperitoneal Space, Direct trocar insertion, Hasson open technique

表1 两组行后腹腔镜手术患者一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		体质量指数[kg/m²，(±s)]	手术分类(例)							既往腹腔镜手术史(例)
组别	例数	年龄[岁，(±s)]	男	女	体质量指数[kg/m²，(±s)]	a	b	c	d	e	f	g	腹腔镜	后腹腔镜
改良Trocar直接穿刺法	107	60.54±14.13	65	42	24.91±2.54	41	24	5	14	17	5	1	10	3
Hasson开放穿刺法	98	60.90±11.79	54	44	24.58±2.51	43	21	2	12	14	2	4	9	6
统计值		t=0.200	χ²=0.670		t=0.920	χ²=1.295							χ²=0.002	χ²=0.668
P值		0.841	0.413		0.359	0.243							0.968	0.414

表1 两组行后腹腔镜手术患者一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		体质量指数[kg/m²，(±s)]	手术分类(例)							既往腹腔镜手术史(例)
组别	例数	年龄[岁，(±s)]	男	女	体质量指数[kg/m²，(±s)]	a	b	c	d	e	f	g	腹腔镜	后腹腔镜
改良Trocar直接穿刺法	107	60.54±14.13	65	42	24.91±2.54	41	24	5	14	17	5	1	10	3
Hasson开放穿刺法	98	60.90±11.79	54	44	24.58±2.51	43	21	2	12	14	2	4	9	6
统计值		t=0.200	χ²=0.670		t=0.920	χ²=1.295							χ²=0.002	χ²=0.668
P值		0.841	0.413		0.359	0.243							0.968	0.414

图1 改良Trocar直接穿刺法在后腹腔镜手术中的应用注：图a为切开髂嵴上方穿刺点，图b为Trocar直接穿刺，图c为镜体分离平面，图d为镜体分离间隙前缘，图e为镜体分离间隙后缘，图f为建立腹膜后腔

表2 两组行后腹腔镜手术患者手术相关数据比较

组别	例数	建立后腹腔时间[min，(±s)]	Trocar漏气(例)	穿刺相关并发症(例)			术后切口疼痛应用止痛药(例)	VAS[min，(±s)]	切口感染(例)	术后住院天数[d，(±s)]
组别	例数	建立后腹腔时间[min，(±s)]	Trocar漏气(例)	腹膜损伤	重度皮下气肿	气囊破裂	术后切口疼痛应用止痛药(例)	VAS[min，(±s)]	切口感染(例)	术后住院天数[d，(±s)]
改良Trocar直接穿刺法	107	6.6±1.8	5	2	2	0	22	3.13±1.79	2	6.67±1.79
Hasson开放穿刺法	98	9.7±1.5	13	7	2	2	26	3.39±1.80	4	7.05±2.07
统计值		t=13.630	χ²=4.715	χ²=4.227			χ²=1.017	t=1.026	χ²=0.275	t=1.401
P值		<0.001	0.030	0.039			0.313	0.306	0.600	0.162

表2 两组行后腹腔镜手术患者手术相关数据比较

组别	例数	建立后腹腔时间[min，(±s)]	Trocar漏气(例)	穿刺相关并发症(例)			术后切口疼痛应用止痛药(例)	VAS[min，(±s)]	切口感染(例)	术后住院天数[d，(±s)]
组别	例数	建立后腹腔时间[min，(±s)]	Trocar漏气(例)	腹膜损伤	重度皮下气肿	气囊破裂	术后切口疼痛应用止痛药(例)	VAS[min，(±s)]	切口感染(例)	术后住院天数[d，(±s)]
改良Trocar直接穿刺法	107	6.6±1.8	5	2	2	0	22	3.13±1.79	2	6.67±1.79
Hasson开放穿刺法	98	9.7±1.5	13	7	2	2	26	3.39±1.80	4	7.05±2.07
统计值		t=13.630	χ²=4.715	χ²=4.227			χ²=1.017	t=1.026	χ²=0.275	t=1.401
P值		<0.001	0.030	0.039			0.313	0.306	0.600	0.162

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Comparison of the application of modified direct trocar insertion and Hasson open technique in retroperitoneal laparoscopic surgery

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Comparison of the application of modified direct trocar insertion and Hasson open technique in retroperitoneal laparoscopic surgery